Kerendia (Finerenone) Uses and Indications
Kerendia (finerenone) is primarily used to reduce the risk of kidney disease progression and cardiovascular complications in adults with chronic kidney disease (CKD) associated with type 2 diabetes (T2D) who are already on maximum tolerated doses of ACE inhibitors or ARBs. 1
Primary Indications
Finerenone is specifically indicated for:
- Reducing the risk of sustained estimated glomerular filtration rate (eGFR) decline
- Preventing progression to end-stage renal disease (ESRD)
- Reducing cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure
- Treating patients with albuminuria (ACR ≥30 mg/g) 1, 2
Patient Selection Criteria
Finerenone therapy is appropriate for patients who meet the following criteria:
- Type 2 diabetes with chronic kidney disease
- Already on maximum tolerated doses of ACE inhibitors or ARBs
- eGFR ≥25 ml/min/1.73 m²
- Serum potassium <4.8 mmol/L 1
Dosing Guidelines
Dosing is based on baseline renal function:
- 10 mg once daily for eGFR 25-60 ml/min/1.73 m²
- 20 mg once daily for eGFR >60 ml/min/1.73 m² 1
Clinical Benefits
Finerenone has demonstrated significant cardiorenal protective effects:
- 23% reduction in kidney disease progression (HR 0.77,95% CI: 0.67-0.88)
- 14% reduction in composite cardiovascular events (HR 0.86,95% CI: 0.78-0.95)
- 29% reduction in hospitalization for heart failure (HR 0.71,95% CI: 0.56-0.90)
- 32% reduction in new-onset heart failure (HR 0.68,95% CI: 0.50-0.93) 1, 3
These benefits are observed regardless of baseline atherosclerotic cardiovascular disease history 1.
Safety Monitoring
The primary adverse effect of finerenone is hyperkalemia:
- Incidence of 10.8% with finerenone vs. 5.3% with placebo in clinical trials
- Requires monitoring of serum potassium and renal function:
- At baseline
- 1 month after initiation
- Every 4 months thereafter 1
Contraindications
Finerenone should not be used in patients with:
- Adrenal insufficiency
- eGFR <25 mL/min/1.73 m²
- Serum potassium >4.8 mmol/L 1
Combination Therapy
Finerenone can be effectively combined with:
These combinations provide additive cardiorenal protection, making finerenone an important component of comprehensive management for patients with diabetic kidney disease 1, 5.
Clinical Pearls
- Finerenone is a non-steroidal mineralocorticoid receptor antagonist, distinct from steroidal agents like spironolactone
- Unlike spironolactone, it does not cause gynecomastia 5
- It has balanced effects on both heart and kidneys, making it particularly valuable for patients with both diabetic kidney disease and cardiovascular risk 3, 4
- Discontinue finerenone if serum potassium exceeds 5.5 mmol/L despite medical management 1